Vascular Complications
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The photo below shows a patient who has an impending necrosis. She was treated for the necrosis within 24 hours of injection. She received Hyaluronidaise to breakdown and remove the Restylane which was injected under her eye area. She was able to recover without tissue loss. She remained on a blood thinner for a prescribed time. She lost all the product she had paid for in her treatment, unfortunately. 

How Vascular Injury Happens

- The potential for Vascular Injury is at the needle tip, hidden under the skin.

- Stillness of the needle is essential for accurate Aspiration.

- A vessel may or may not be cannulated to cause tissue damage.

- A vessel may be compressed with or without laceration.

- A vessel may be lacerated, drop pressure, then compressed by filler, 

  oozing blood, inflammation, or all of the above.

- A white flash may be visible in the skin during injury, or it may not.

- You could miss the "flash."

- A bruise may be visible by the end of the injection session, or not.

- A bruise may be delayed, may show up hours later, or not.

- There may be intense pain at the time of injury and the pain may persist, or not. 

- The patient's pain may seem out of proportion to the TX and occur suddenly. 

- The patient may experience delayed, alarming, severe pain hours after TX.

- A mottled or lacelike appearance of discoloration may appear near the injection site.

- A vasospasm can precede a vascular injury depending on circumstances. 

- If your patient has a vascular injury, it is best to address it immediately to avoid damage. 

Dermal and soft tissue filler safety profiles have increased significantly since the bovine fillers first became available in the United States over 20 years ago. Our work at Smart Injector, LLC is to deliver products for aesthetic injectors using dermal and soft tissue fillers that improve aspiration ease, manual control, reduce fatigue, improving the injector/patient experience.

Recently, we over heard a conversation which anecdotally claims that Aspiration doesn't work... This argument is based on a theory that the rheostatic properties of gel dermal fillers prevent the pressure to pull blood into the needle hub. 
A demonstration has been done with an open fluid container in place for the human body, showing a failure to draw fluid into the syringe.
However, the body is a closed, pressurized system. You cannot use an open container of fluid to validate Aspiration. During #ASPIR8R™n our training, we have witnessed blood aspirate in the hub and watched some of the visible cascade of events that happen after vessel damage. 

If the needle hub is colored, you may not immediately see blood in the hub. Train your eye. Please see the photo below which is blood in the hub of an aspirated full juvederm syringe. The needle is a 30 guage, half inch, BD.

See below! This photo was taken in a live injection training.